Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4933

2. Registrant Information.

Registrant Reference Number: 1-34672321

Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation

Address: 400 Plaza Drive

City: Secaucus

Prov / State: New Jersey

Country: USA

Postal Code: 07094-3688

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

20-AUG-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

17-AUG-13

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No. 29283      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard Pro Flea/ Tick Drops for Dogs/ Puppies Under 30 pounds

• Active Ingredient(s)
  • (S)-METHOPRENE
  • PERMETHRIN

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PMRA Registration No. 29930      PMRA Submission No.       EPA Registration No.

Product Name: Ultraguard One Spot Flea, Egg/Larvae Treatment for Cats/Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Animal / Usage sur un animal domestique

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Teacup Yorkie

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Hair loss

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-34672321 - The reporter, a pet owner, indicated that her dog was exposed to a spot-on insecticide containing the active ingredients methoprene and permethrin and her cat was exposed to a different spot-on insecticide containing the active ingredient methoprene. The reporter indicated that she applied the dog spot-on product to her 7 year old, male teacup Yorkie (Subform III #1) about one month prior to initial contact with the registrant and she applied the same product again three days prior to initial contact. The reporter indicated that her teacup Yorkie has been suffering from generalized hair loss for the past month. The reporter was advised that there were numerous possible causes for hair loss in her dog and generalized hair loss is not consistent with exposure to the product. Veterinary care was recommended to determine an underlying cause and appropriate treatment. The reporter applied the cat spot-on product to her 2 year old, female domestic longhair (Subform III #2) three days prior to initial contact with the registrant. Immediately after the product was applied the cat licked the application site and within 24 hours the cat lost its appetite, was not drinking, was lethargic, had brownish discharge from its eyes and squinted when it was in the light. The reporter was advised that the active ingredient in the cat spot-on product have little to no toxicity in mammals and the described symptoms are not consistent with exposure to the product. Veterinary care was recommended to determine an underlying cause and appropriate treatment. The reporter could not be reached on follow-up. No further information is available.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Longhair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

25

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Adipsia
  • Specify - Not drinking

• Eye
  • Symptom - Photophobia
  • Symptom - Discharge eye

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-34672321 - The reporter, a pet owner, indicated that her dog was exposed to a spot-on insecticide containing the active ingredients methoprene and permethrin and her cat was exposed to a different spot-on insecticide containing the active ingredient methoprene. The reporter indicated that she applied the dog spot-on product to her 7 year old, male teacup Yorkie (Subform III #1) about one month prior to initial contact with the registrant and she applied the same product again three days prior to initial contact. The reporter indicated that her teacup Yorkie has been suffering from generalized hair loss for the past month. The reporter was advised that there were numerous possible causes for hair loss in her dog and generalized hair loss is not consistent with exposure to the product. Veterinary care was recommended to determine an underlying cause and appropriate treatment. The reporter applied the cat spot-on product to her 2 year old, female domestic longhair (Subform III #2) three days prior to initial contact with the registrant. Immediately after the product was applied the cat licked the application site and within 24 hours the cat lost its appetite, was not drinking, was lethargic, had brownish discharge from its eyes and squinted when it was in the light. The reporter was advised that the active ingredient in the cat spot-on product have little to no toxicity in mammals and the described symptoms are not consistent with exposure to the product. Veterinary care was recommended to determine an underlying cause and appropriate treatment. The reporter could not be reached on follow-up. No further information is available.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here